Gastric Tumour

[biscuity]

Hi Katie

I am sorry to hear about your Katie. Our vet in Liverpool is Kevin, although we are back on the Isle of Man now being looked after by our own vet. It's a big trip for us to Liverpool.

My cat's name is Marmite. We got referred to Liverpool so that they could diagnose exactly what was wrong with Marmite. They are too expensive & too far for us to use regularly, but they are also supporting our local vet with expert advice.

 

[ldg]

Aw.... The stress of getting the meds into her was just not helping the situation! I know this is hard, but being able to get most of what she needs via IV is probably the best idea right now. :heart3:

To help soothe her stress, get a t-shirt or something really good and sweaty, and go drop it off to be put in with her. :heart3: It will be comforting for her.

...and in the meantime, see if you can't find some place that may be able to compound those meds into something she'll eat - or at least eat if mixed with a little wet food or something. :rub:

 

[biscuity]

We left one of Marmite's window sill blankets for her. Most of our Window sills either have cat aerobic centres or blankets for Marmite.

I asked a local chemist about the compound meds & they said that it's a specialist job & very expensive to do. I also asked the vet who said that they couldn't do it in a reasonable time frame because it would need each product to be tested & checked that the flavours would not affect either the chemistry of the meds or the absorption rate. She didn't think it was viable, unfortunately. I will ask about mixing with wet food, but some of the meds we are using are for humans & the vet told me that Marmite would just refuse the food. The meds were set my Liverpool hospital who are using some quite advanced meds that isn't certified for animals. I will keep plugging away at the idea though, thank you.

 

[ldg]

Aw, I'm sorry to hear that. I understand the logic of the vet... but most people have to put meds in some kind of food to get their animals to eat them anyway. :dk:

 

[katiesmummy]

Sorry to hear about the problems you are having with Marmite's tablets. As a Pharmacist myself I can confirm that we have to order special formulations from particular labs , we haven't been allowed to do our own formulations since 1995 and these labs charge us about £400 just to mix a bit of powder in a flavoured formulation! I would like to know what tablets Marmite is on and maybe I could offer some advice on how to get them down her - it is fairly unlikely that tablets would react with foodstuffs and as a rule if the tablet is non bitter tasting it could be placed in cheese, a piece of chicken or in Katie's case clotted cream which she loves! You should never grind a tablet to powder or cut it without asking advice, as this could be dangerous with sustained release formulations. Some tablets eg fortekor are very palatable and cats will take them like treats. It is pretty difficult to disguise a bitter pill although sometimes this can be achieved if you use a strong cheese eg cathedral city mature cheddar. Also if you store tablets in the fridge they lose their taste so will be more palatable to the cat. I hope this is of some help! Also with regard to cost of tablets, vets now have to by law offer you the option of going to a Pharmacist for your tablets - often the Pharmacist's prices will be cheaper - I tend to undercut the vets but it is up to the individual Chemist what they charge. We have access to the same wholesalers as the vets. Love and purrs to u both.

 

[biscuity]

Thanks for your reply.

We were first giving Marmite some Buprenorphine, but that was really for a week post the endoscopy procedure. We have 3 pre drawn oral syringes left unused.

We have been giving her Famotidine of a mg tablet twice daily. On the hospital instructions, we crush the quarter tablet in a pestle & mortar & dissolve it in .25ml water & then syringe it orally.

We also give her Sucralfate .25ml that should be 3 times daily by mouth, but we give it twice daily so that we only stress out Marmite twice a day.

In addition, the vet has on Monday given Marmite a steroid injection to reduce stomach inflammation. This unfortunately would have a negative effect on her other problems. But reliving sickness has become the priority.

Marmite is currently at the vet & getting 2 additional meds as well. One is for the gasteritis & there is a 3 times daily med for helacopta spiral bacteria which they are trying to treat aggressively. She is also getting fluids by IV & also some pain meds for the ulcer. She is also getting something for her sickness. I don't know what any of those meds are called yet.

The vet called this morning & said that Marmite has not been sick in the night. She has been very stressed in the vets & has only eaten a small amount. This is more that I have managed over the past 5 days as my poor Marmite has sicked up everything she has eaten.

 

[biscuity]

My vet allowed me to visit Marmite today as she is still not eating. But she also has not been sick.

My poor baby is very stressed & upset at the vets, she is scared there. I spoke to all of the vet nurses & they are being very kind with Marmite. They just open the cage to talk to her & also give her strokes & chin tickles - which Marmite likes. I brought along a different flavour of Marmite's treats & also he dinner dish to try to encourage her to eat. I was not able to get her to eat, although Marmite did seem to relax a little after a while. Later, the vet gave her some vallium by IV & this triggered her to eat. She has now eaten a fair amount of food & treats & also been drinking some water. They are now going to watch her for sickness over night & I detailed what types of sickness she has been having & it's appearance.

I had made a spelling error with the bacteria she has, it's called helicobacter & it's a bacteria that causes gastritis which then can cause ulcers. (http://en.wikipedia.org/wiki/Helicobacter_pylori) We had been treating the ulcer, but now the vets are treating all three, the bacteria, gastritis & the ulcer.

Marmite has an IV tube going to her front leg & she really doesn't like it at all. I really want to get her home, but need to think what's best for Marmite as she is getting all her meds at the moment. She is upset, scared & uncomfortable so it's a fine line what would be best for her. I think that she would eat ok at home, but if they can get her eating in the vets then it's the best place for her over the next few days. If they can stop the sickness, then Marmite can come home where she will be much happier & more comfortable. It's very strange her not being here, I'm so used to looking for Marmite when I'm at home.

 

[darlili]

Poor little girl - and poor you.  I hope she has a good night and makes progress toward coming home.

 

[biscuity]

The vet called this morning, Marmite was not sick last night & she discussed letting her home either today or Saturday. The vet felt is was best for Marmite to get another day's IV meds & let her home on Saturday. The vets are going to have to change the IV vein today.  Marmite is very stressed at the vets, but she is getting her meds. She's not eating again today, so they will give her vallium again this afternoon by IV to get some more food in her. I hope that when she gets home, she will eat again. Once she is home, we will have to give her 4 lots of oral meds twice a day for another 2 weeks. One of those meds can be injected, but the vet was concerned about the effect that so many injections would have on her scruff behind her head, so we will go with orals. So we are collecting Marmite at 10am tomorrow & I hope that she starts eating again once she gets home & we can keep away the sickness. With the sickness away, 2 weeks of meds & her eating, we should be able to help her recover.

 

[ldg]

Well it's great news she wasn't sick! Hopefully the valium will help with her ability to eat. :cross:

Poor baby's so stressed, I'm really glad she'll be coming home!!!

things will go more smoothly with medicating her at home this time. You're more comfortable with the technique, and hopefully your confidence will help reduce the stress. :heart3:

 

[biscuity]

I got another update phone call. Marmite is a little happier, but not that much. The nurse has noticed that since Marmite ate a little yesterday, she has perked up a little & is coming to the cage bars to rub against them. She may be feeling a little more comfortable as they changed the leg for the IV tube too. They have given her vallium again today to get her to eat some more, no sickness as at my last update early evening. Also they talked with Liverpool hospital & have given her another steroid injection to reduce gastric swelling over the weekend. I am collecting Marmite at 10am tomorrow & there will be 5 lots of oral meds for her, twice a day. We will be in the 3rd week for 2 or the meds, so we have 5 meds for this week coming, then dropping to 3 meds twice a day. It's going to be very hard work getting those meds into my baby. As far as the vet is concerned, our main aim is to get Marmite eating & not being sick.

 

[biscuity]

We collected Marmite this morning, she was very pleased to see us & perked up on the way home in the car. Once home, we could see that she was very unsteady on her feet & very tired, she kept laying down. Over the rest of the day, she has checked out the house, laying down frequently to rest. She slept in her bed on the floor & then for a short time slept behind our wardrobe. She has had a little drink of water & had a wee. The rest of the time, she has been in bed. We have all the extra meds for her & there is a lot to give to her. We had a lot of trouble giving her 3, now we have 5 to give her & one of those is a lot of medicine that will take several squirts to get it all in.

 

[ldg]

Has she eaten since she's been home? She may also be weak because she's eaten so little.

If she's hungry at all, have you tried giving her treats after each administration of medicine? That's how we're handling it with our Flowerbelle, who stresses and flails her head and arms when being medicated. It (knock wood) seems to be working, but inappetance wasn't one of her issues.

you're able to get her to eat, and find a reasonably comfortable way to get her meds into her. It SHOULD get easier with time.... :cross:

BTW, I don't know how you're getting meds into her. I saw the video to which you provided the link. I don't know if this will help you at all, and I'm really sorry if this is a repeat of information I've shared before. I don't know how it would work as a two-person operation, but let me describe how I pill a cat, and maybe it will help you figure out something that will make the process go more quickly. The same basic principle applies whether a pill or liquid. :nod:

Kneel on the floor with your knees pointed out in a "V", your feet under your butt, with your butt on your heels. Cat should be fairly tightly in the "V." As they described in that video, the cat has convenient bone structure on head, so that there are kind of "handles" on the sides of the head when you put a hand over the head to hold it steady. I use my index finger at the back of the jaw to "push" the mouth open with the same hand that's holding the head. With pills, I then push the pill in with the index finger of my other hand, over the hump in the toungue. Same principle if a liquid, put the syringe in.

The "V" helps prevent the cat from moving, and the more you do this, the quicker you can do it. I catch my cats generally when they're eating - their natural reaction is to back up. With this sitting position, there is no way to back up, and the pill is usually in and done before they can struggle too much. I know you have to give a number of meds, but IF you do this in a smaller place, like a bathroom, that may help too.

And if she has any favorite foods, maybe - even if not now - but a few days from now? - maybe giving her some treats between meds will help? :dk:

 

[biscuity]

Marmite has not eaten at all since she has been home, she has drunk a little. So at the moment, she has not eaten normally since Friday 25th November. When she was feeling better, ate a little & then sicked it up 4 times over the rest of the day & night. She ate several times at the vet hospital when given IV vallium. She was also getting IV fluids at the vet. Now that she is home, we can see that she is very weak & of course she hates getting the meds. We are still using the YouTube video system & that seems to work ok as she does not struggle so much. However she froths up the meds & it's very difficult to get them down her. We are spending each time we give the meds, several minutes calming her & cleaning her up after each med. It is really dreadful for us & for Marmite.

I feel that eating is an issue now, she cannot be tempted with anything. Regular food, wet food given to us by the vet, her treats, nothing.

We have a couple more meds to give her at lunchtime as we stopped this morning when she was getting so upset & we were worried that she would choke. We are considering liquidising a little of the wet food & squirting that into her mouth to try to get her to taste it. Any thoughts on this please?

 

[ldg]

I couldn't understand why the vet wasn't syringe feeding her to begin with. But cats are not like people. Their bodies are not designed to use fat reserves for energy. In fact, if they do not eat enough food and their bodies begin to "eat" fat and muscle, in cats this can be fatal. It damages their livers. It is called hepadic lipidosis, or fatty liver disease. It is correctable if caught early enough, and the "cure" is food! But it also starts a cycle where the cat does not feel hungry, and will not eat. The only solution to break this cycle is force feeding.

Personally, I am shocked your vet has not told you this information. And there is quick and easy solution, although perhaps the infection is why they didn't mention it? I would definitely call to ask, but basically they can perform quick, easy surgery (take her home same day kind of thing) where they install a "feeding tube," like a little port, into her esophagous! And then no more stress getting liquid meds OR wet food into her.

 

[ldg]

...but the bottom line is she must eat, or her liver will begin to fail, and she needs the meds to keep the food down.

Please talk to them about a feeding tube. Was bloodwork done right before they sent her home? Because I would be very surprised, given how little she's eaten or kept down, if she is not in the early stages of fatty liver disease.

 

[biscuity]

I will call the vet tomorrow morning, they are expecting a call from me anyhow. I have taken Monday off work again. I don't think that any bloods were done before Marmite left the vet on Saturday.

I had no idea about the feeding tube possibility.

We had a bad time giving Marmite the meds this morning that left us both in tears. We are torturing her, she makes a quiet pitiful sound in her throat that is soul destroying to hear. We were already considering that being at home does not seem to be helping her, she is certainly not eating, which the vet had hoped & also Marmite has two useless vet nurses in the two of us, so she is not getting all her meds properly. She did sleep on the bed next to me in the night, which was nice, but I'm considering whether to ask the vet to take her back to the vet hospital & treat her there for the remaining 2 weeks. We are not doing it properly, although we are better than we were as Marmite is too weak to fight much. I feel that Marmite does not need two newbie nurses, she needs the best care & she needs to get all the meds down her & needs to eat. The feeding tube possibility may turn this around.

What do you think?

 

[biscuity]

We tried a syringe of liquidised wet food this afternoon. She took it like it was meds & fought quite hard to get away. Afterwards, I carried her back upstairs & she went beside the wardrobe again. Shortly afterwards, she came out & laid in front of our dresser nearby & I think that she was in pain. Breathing through her mouse & sometimes pawing the carpet. I was scared & called the emergency vet service. While we were talking for a good 20 minutes, Marmite calmed down & had a very long drink of water. The vet thinks that it may be pain from her ulcer & she may have drunk the water to sooth the pain. he suggested also offering some lukewarm milk, but she has not drunk any. She has now gone to sleep, I check on her every now & again. I don't want to stress her any more, by giving any more meds tonight. The vet offered to take her in now, but I think that we will wait until Monday morning to give Marmite a nice night's sleep. I discussed with the vet about the tube & he said that it is probably what they will do next as Marmite is difficult to medicate. He said that it must be done under general anaesthetic, so I hope that Marmite will be ok due to her heart murmour. He also said that sometimes they put a tube down her nose instead of the direct tube.

We are very upset & may not be thinking straight, is there anything I should be asking?

 

[ldg]

If I were you, I would call the specialists at Liverpool, or ask the local vet to call to consult with them on the best option. I BELIEVE she would have had to been anesthetized to take the biopsy to rule out cancer. I'm sorry, I do not recall what level of heart murmur problem she has, but a short term general anesthetic may not be a problem depending on the severity of the murmur.

Know that with nasal tubes you can only feed a liquid diet due to the small size of the catheter.

While any general anesthesia involves risk for any cat, to insert a feeding tube via esophagus or stomach should require 10 minutes. I would ask the specialists at Liverpool what risk is involved with the anesthesia necessary for an esophogeal or direct-stomach tube vs. nasal, and what would they recommend. And whether it's your vet calling or you calling, I would get an answer Monday, and do something ASAP.

Here are articles for you. But I do believe this is the best option for her, as you can also administer her medication without the stress. I hope you will be able to do an esophageal or stomach tube. She needs the food, not just liquids, IMO, at this point (but I am not a vet!).

http://catinfo.org/?link=feedingtubes (In one of the pictures, they're illustrating what syringe feeding would do - result in copius salivating, so do not be scared that that is a result of the tube feeding. It is not).
http://www.lbah.com/feline/ftube.htm
http://www.marvistavet.com/html/anorexia.html

 

[biscuity]

Thank you so much Laurie

You have given us some hope. I think that the esophageal tube looks more likely to be carried out at our vets. A stomach tube would need Liverpool University again. We will spend the money, but we can't afford the delay. Thank you for pointing out about the nasal tube.